Differences in major joint play testing grades

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The pioneers of joint play testing

The two principal pioneers of joint play testing in manual therapy are Geoffrey Maitland of Australia, and Freddy Kaltenborn of Norway. Both individuals developed techniques for the extremities and spine, and both developed different scales for describing the force and movement used during testing and treatment.

Essential Differences between the Australian and the Nordic Approach

During the development of his approach, Maitland was strongly influenced by the neurophysiologic principles relating to pain. Kaltenborn on the other hand was influenced by the joint based mechanical approaches advocated by Cyriax, Mennel, and Stodard.

1. Basic differences in approaches:
Maitland’s approach (non-diagnostic approach): Maitland’s approach uses angular motions in the extremities when looking at joint play. Logically, angular movements of the long bones may be used to identify abnormal resistance due to muscle guarding, muscle tone, or articular restriction. However, because of its gross nature, it is difficult to judge whether articular or neuromuscular impairments are causing a particular movement restriction.

Kalternborn’s approach: Drawing from simple mechanical principles Kaltenborn reasoned that there are two types of movement available in a joint: rolling and gliding. Understanding that, excessive loading (sheer and compression) leads to articular cartilage degeneration Kaltenborn chose to emphasize straight-lined, translational (gliding) movements during joint examination, mobilization, and manipulation. His techniques are performed using very small amplitudes of movement with forces applied close to the joint line.

2. The scales developed: The scales developed by Maitland and Kaltenborn are equally dissimilar. Kaltenborn’s scale looks at resistance within the range while Maitland’s scale looks at the amplitude of oscillations within the range. Some manual therapy systems integrate these two scales which causes confusion for the novice manual therapist.

3. Kaltenborn & Maitland’s Initial Treatment Directions: Kaltenborn and Maitland target their initial treatments differently. Maitland advocated treating patients with pain by directing oscillations towards the direction of movement causing pain (but not into pain). Kaltenborn on the other hand emphasized treating to improve function using directions that cause the least amount of pain.

(excerpt from my manual therapy class:8)

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